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#0522-RS7070-AC
Supplemental Questionnaire

Last Name
First Name
1

Education: Have you graduated from an accredited college or university with major coursework in social work, social  science, public administration or a related field?

Yes No
1a.

If yes, please list:

A) The college or university you attended

B) Major

C) The number of units completed

2.

Please explain in detail at least two years of experience you have in being progressively responsible in a program setting that involved considerable independence and responsibility for project managment, data maintenance/analysis, or funding source compliance.  Please include in your response your employer, job title, hours worked per week and salary.

3.

Do you possess a valid California driver's license?

Yes No
3a.

Candidates must possess and maintain a valid California driver's license.  Provide your valid California driver's license number and expiration date.